NUR137 Assessments 3 Scenario 1: Information for the Patient role

A 26-year-old recently discharged from the military was admitted 4 days ago for psychiatric evaluation after expressing suicidal ideation, supported by a highly lethal plan. The patient was diagnosed with acute depression, and treatment with antidepressants and therapy was initiated. After several telephone calls to his parents on the first 2 days of his hospitalization, the patient appears pleased that they have agreed to visit. They arrive for their first visit on the evening of the third hospitalization day. The patient’s mother is tearful and expresses concern over how the patient is “being treated” and asks “if he is eating well.” The patient’s father paces with crossed arms and makes little conversation or eye contact with the patient. The visit lasts a little less 30 minutes, with the mother promising to call and send a package of clothes and snacks. The father tells his son that they will visit again “sometime” and states, “Son, stop acting this way, because it really hurts your mother.” After the visit, when the nurse asks the patient to discuss the visit, he tells the nurse, “It’s hopeless, nothing changes. I’m tired; I’m going to lay down.” [8:48 pm, 25/8/2024] Navjot Thiara: Day 3 of hospitalization: 1830 post visit Patient visited by parents. Visit lasted 30 minutes. Mother expressed concern over patient’s care and diet, but no focus on suicidal ideations was observed. Father appeared agitated, demonstrated by pacing and crossed arms. As the parents were preparing to leave, the mother promised to call and send clothing and snacks, while the father suggested they would visit again “sometime” and then stated, “Son, stop acting this way, because it really hurts your mother.” When asked to discuss the visit, the patient declined, telling the nurse, “It’s hopeless, nothing changes. I’m tired; I’m going to lay down.” Day 4 of hospitalization: Post team meeting 1200 Patient and family response to initial meeting last evening is the focus of treatment team meeting. Suggested that patient and family attend family counseling session and offer invitation to family to attend specialized family support group meetings. 1300 Patient reports having difficulty falling and staying asleep. Asks for a “sleeping pill.” Healthcare provider notified of request. Day 5 of hospitalization: 0900 Discussed prospect of patient’s involvement in family counseling. Patient stated he was willing if they were. Healthcare provider responds to request for medication to help patient sleep by requesting staff monitor and document patient’s sleep patterns for two additional days. If insomnia persists, medication therapy will be considered. 1400 Patient’s mother called and talked with patient, who discussed the issue of family counseling sessions and family support group involvement. She said she would be willing to attend family counsel and family support group meeting. She volunteered to discuss attending with patient’s father. Day 6 of hospitalization 1200 Met privately with patient for 30 minutes to discuss his feelings of despair. Patient resisted engaging in the discussion and asked to leave early. Day 7 of hospitalization 1200 Met privately with patient for 30 minutes and helped patient identify past events/experiences that have given him hope that his life will improve. Patient appeared more engaged as discussion progressed. 1500 post family session Patient’s mother attended scheduled family counseling session. Mother visited for 1 hour after meeting ended. Provided mother with information regarding community services available to those diagnosed with depression per her request. Patient expressed hopefulness related to mother’s participation in the meeting. Day 8 of hospitalization Met privately with patient to discuss importance of an effective, reliable support system. Day 9 of hospitalization 1200 Met privately with patient to continue discussion on the importance of an effective, reliable support system. Patient displayed interest in identifying two new individuals to include as members of his support system. 1500 post family session and family visit Patient and family including mother, father, and two siblings attended. Father left after 15 minutes. Remaining family visited with the patient for 1 hour, discussing plans to have patient live with older sibling after discharge. [8:49 pm, 25/8/2024] Navjot Thiara: The patient has reached day 9 of hospitalization. The nurse is reviewing nursing notes to evaluate effectiveness of interventions implemented. Which findings indicate that the interventions in the patient’s plan of care have been effectively implemented? Select all that apply. Patient attendance at the private session with nursing staff Father’s attendance at the family counseling session Patient’s reaction to mother’s attendance at the family counseling session Sibling’s presence at family counseling session Mother’s request for community resource information Patient’s reaction to first private session with nursing staff Attention paid by patient to creating effective, reliable support system Family’s engagement in post discharge planning

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